| NPI | 1235181553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME122818) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MN 38847) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2015-12-01 |